Perspectives of people with late age-related macular degeneration on mental health and mental wellbeing programmes: a qualitative study.

PURPOSE: People with age-related macular degeneration (AMD) experience high rates of depression, but rarely engage in or have access to tailored mental wellbeing programmes. This qualitative study investigated the perspectives of those primarily with late AMD on mental health and mental wellbeing programmes. METHODS: Twenty-eight people with late AMD in at least one eye, and one person with early AMD in both eyes, aged 56-87 years (mean age 78 years) attending a private eye clinic between December 2019 and January 2020 in Sydney, New South Wales, Australia, participated. Individual semi-structured interviews were conducted and analysed deductively using content analysis, following the individual level factors for health promotion interventions in the behaviour change wheel: Capability (Physical & Psychological), Opportunity (Physical & Social), and Motivation (Reflective & Automatic). RESULTS: Six major themes were identified: Capability: (1) Impact of vision loss on mobility and leisure pursuits; (2) Adjustment to living with vision loss; Opportunity: (3) Program considerations for those with AMD; (4) Stigma and self-perception of vision loss and mental health; Motivation: (5) Accumulation of vision-related issues as a barrier to participation; (6) Examples of others living with vision loss. General personal factors relevant to delivery of a programme in this age group were also identified: Comorbidities; Limitations using technology; Isolation; Financial concerns and Beliefs that undesired effects of aging are inevitable. CONCLUSIONS: Complex individual, environmental and social factors influence the perspectives of people with late AMD on mental health, and potential participation in mental wellbeing programmes. These factors should be considered when developing and implementing mental wellbeing programmes to improve the emotional and functional rehabilitation outcomes for people with AMD.

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies.

Although the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.

An Examination of the Folk Healing Practice of Curanderismo in the Hispanic Community.

Curanderismo is a system of traditional folk practices and beliefs that address health and healing in the Hispanic community. Curanderismo serves a function in the daily lives of Hispanics worldwide, providing them access to culturally appropriate healthcare, and agency over their own, and their family's health. Cultural competency in the area of curanderismo is invaluable, as curanderismo is a folk resource that if acknowledged and embraced by nurses and healthcare practitioners can aid in healthcare delivery and increased healthcare utilization among Hispanic populations.

Walking the Labyrinth: Considering Mental Health Consumer Experience, Meaning Making, and the Illumination of the Sacred in a Forensic Mental Health Setting.

The purpose of this study is to explore the unique meaning and experience associated with walking a unicursal seven circuit outdoor Chartress Labyrinth and 11 circuit indoor Chartress Labyrinth for persons residing at a forensic mental health care facility. Over the past several decades labyrinths have enjoyed something of a renaissance and are often utilized by spiritual care practitioners and health care clinicians in order to support reflection, stress reduction, and the exploration of personal wellness in a sacred setting. Labyrinths are used in many settings including places of worship, hospitals, long-term care facilities, and parks. While labyrinths are becoming more prevalent, an understanding of their impact, particularly in the mental health context, is limited. This qualitative study supports a novel investigation of the meaning associated with participation in walking a labyrinth for persons residing at a forensic mental health care facility. The study design is a qualitative methodology involving transcribed interviews with 12 individuals resident at the Southwest Centre for Forensic Mental Health Care who participated in the 'Walking the Labyrinth' program as facilitated by spiritual care staff. A standardized interview protocol was utilized and the collected data was coded for themes. Several methods were employed to establish trustworthiness including triangulation by analyst and by theory/perspective. Member checking was also utilized in order to further validate the themes. Recommendations related to potential health care applications for labyrinths are identified. These include a focus upon the linkage between mental health care planning and labyrinth participation.

The healing process following a suicide attempt: context and intervening conditions.

The purpose of this study was to explore the context and the intervening conditions that impacted on individuals' healing from a suicide attempt. Patients who had survived a suicide attempt (n=14) and their caregivers (n=6) were interviewed in this study. Findings revealed that the suicidal individuals who lived in a sheltered, friendly environment, and had support systems helped their suicidal healing process. Conversely, suicidal individuals who experienced negative aspects of self, family predicaments, environmental difficulties, and the re-emergence of stressors impeded their suicidal healing process. Consequently, health professionals need to promote healthy internal and external environments for suicidal individuals.

Pain attenuation through mindfulness is associated with decreased cognitive control and increased sensory processing in the brain.

Pain can be modulated by several cognitive techniques, typically involving increased cognitive control and decreased sensory processing. Recently, it has been demonstrated that pain can also be attenuated by mindfulness. Here, we investigate the underlying brain mechanisms by which the state of mindfulness reduces pain. Mindfulness practitioners and controls received unpleasant electric stimuli in the functional magnetic resonance imaging scanner during a mindfulness and a control condition. Mindfulness practitioners, but not controls, were able to reduce pain unpleasantness by 22% and anticipatory anxiety by 29% during a mindful state. In the brain, this reduction was associated with decreased activation in the lateral prefrontal cortex and increased activation in the right posterior insula during stimulation and increased rostral anterior cingulate cortex activation during the anticipation of pain. These findings reveal a unique mechanism of pain modulation, comprising increased sensory processing and decreased cognitive control, and are in sharp contrast to established pain modulation mechanisms.

Healing through reflective writing: Breast cancer survivors' experience.

This article describes an intervention for breast cancer survivors called Journal of My Medical Experiences in which participants engaged in reflective writing over six weeks. The 107 participants were encouraged to explore concerns and issues in a safe online environment. About half of the women posted writings to a website once a week or more; others logged on solely to read what others had written. A number of themes emerged as the women explored their feelings. We share some of those.

The foundation of physicianship.

Although the practice of medicine continually changes in response to new biomedical understanding, novel technologies, and evolving cultural contexts, the ethical foundations of the clinical relationship between patient and physician paradoxically remain constant. There are fundamental characteristics with respect to character, behavior, and responsibilities that are descriptive of and necessary to the role of healer and that underpin the notion of physicianship. This article discusses the underlying characteristics or virtues that are necessary to the practice of medicine from the perspectives of three different philosophic traditions: the Aristotelian idea of phronesis as developed in the work of Edmund Pellegrino; the notion of alterity as framed by Emmanuel Levinas; and the attributes necessary to healing as laid out in the kabbala.

Psychoactive ubulawu spiritual medicines and healing dynamics in the initiation process of Southern Bantu diviners.

The use of psychoactive plants by traditional healers in southern Africa appears to be a neglected area of ethnobotanical research. This article explores the healing dynamics involved in the use of popular psychoactive plant preparations known as ubulawu in the initiation rituals of Southern Bantu diviners. Research methods include a review of the literature, fieldwork interviews with Southern Bantu diviners, and an analysis of experiential accounts from diverse informants on their use of ubulawu. Findings reveal that there is widespread reliance on ubulawu as psychoactive spiritual medicines by the indigenous people of southern Africa to communicate with their ancestral spirits--so as to bring luck, and to treat mental disturbances. In the case of the Southern Bantu diviners, ubulawu used in a ritual initiation process acts as a mnemonic aid and medicine to familiarize the initiates with enhanced states of awareness and related psychospiritual phenomena such as enhanced intuition and dreams of the ancestral spirits, who teach the initiates how to find and use medicinal plants. The progression of the latter phenomena indicates the steady success of the initiates' own healing integration. Various factors such as psychological attitude and familiarization, correct plant combinations/synergy and a compatible healer-initiate relationship influence ubulawu responsiveness.

[Mind-body connection, parapsychological phenomena and spiritual healing. A review]. / Conexión mente-cuerpo, fenómenos parapsicológicos y curación espiritual. Revisión.

Evidence regarding the influence of the mind on the body is abundant. Several mind-body healing procedures are currently being used, among them hypnosis, biofeedback, meditation, visualizations, management of emotions and prayer. Since the Big Bang, we are entangled with everything. This interaction would let individuals to communicate with the minds and bodies of others. The field of parapsychological research has provided a lot of information about significant events, including apparitions, communications with the dead, near-death experiences and out of the body experiences. It looks apparently evident, that consciousness can persist in the absence of brain function. According to the model that assumes that it is consciousness and not matter, the base of everything that exists, what survives after death is the "quantum monad" or spirit. It is said that spiritual cures are practiced by discarnate physicians who diagnose and prescribe conventional treatments, but very often they use unknown procedures based on the management of energy fields that are currently being studied by many physicists. Representative examples of the practice of spiritual medicine were the mediums Ze Arigo, George Chapman, Barbara Guerrero (Pachita) and presently the Brazilian medium John of God. Case reports of paranormal phenomena observed and studied by honest and serious scientists are very important for the advancement of parapsychology, because it has not been clearly established which approach, the qualitative or the quantitative, is more useful for the development of this field.

Life satisfaction in chronic pain patients: the stress-buffering role of the centrality of religion.

Chronic pain (CP) is a stressful condition that severely impacts individuals' lives. Researchers have begun to explore the role of religion for CP patients, but the literature is scarce, especially for West European populations. Drawing from the transactional theory of stress, this study examined the associations between the religious meaning system and the life satisfaction for a group of CP patients who were members of a Flemish patients' association. To take into account the religious landscape of West European countries, the centrality of one's religious meaning system, rather than religious content, was the focus. Results from the questionnaires completed by 207 patients suggest that the centrality of a meaning system is an important factor in the promotion of life satisfaction for this group, above and beyond the influence of several control variables. Furthermore, the centrality of the religious meaning system moderated or buffered the detrimental influence of pain severity on life satisfaction.

What type of survey research questions are identified by adults as upsetting? A focus on child maltreatment.

BACKGROUND: Research on child maltreatment is imperative to inform evidence-based prevention and intervention efforts. Nonetheless, researchers continue to face barriers due to the perceived sensitivity and possibility of harm when asking about these experiences. While studies have started to explore reactions to participating in research on sensitive topics, there are notable limitations and fewer have focused on child maltreatment. OBJECTIVE: The objective of this study was to better understand adult respondents' identification of, and reactions to, potentially upsetting questions in the context of a well-being and experiences survey, with a focus on child maltreatment. METHODS: Data were from the first wave of the Well-Being and Experiences Study in Manitoba, Canada: a computerized self-reported community-based survey of adolescents and their parents/caregivers administered individually at a research facility. The current study focused on parents/caregivers' responses (N = 1000). The study utilized a mixed methods approach with descriptive statistics and qualitative thematic analyses of open-ended responses of their perceptions of upsetting questions. RESULTS: Overall, few respondents (15.1 %) identified any questions as upsetting. Ten themes emerged in respondents' recall of upsetting questions, including maltreatment and other themes often perceived as less sensitive. Only 4% identified maltreatment-related questions as upsetting. Among those who identified any questions or maltreatment-specific questions as upsetting, most felt they were important to ask and should not be removed (92.7 %-97.5 %). These findings suggest that retrospective survey questions about experiences of child maltreatment involving adult samples are not associated with major upset and should be included in future health and social surveys.

The placebo effect: illness and interpersonal healing.

The placebo effect has been a source of fascination, irritation, and confusion within biomedicine over the past 60 years. Although scientific investigation has accelerated in the past decade, with particular attention to neurobiological mechanisms, there has been a dearth of attention to developing a general theory of the placebo effect. In this article, we attempt to address this gap. To set the stage, we review evidence relating to the reality and clinical significance of the placebo effect. Next we investigate the scope and limits of the placebo effect by examining the hypothesis that the placebo effect operates predominantly by modifying the experience and perceptions of illness symptoms, such as pain, anxiety, and fatigue, rather than by modifying the pathophysiology of disease. Based on this background, we characterize the placebo effect as a form of interpersonal healing, as distinct from spontaneous natural healing and from technological healing dependent on physiologically active pharmaceuticals or procedures. Finally, we argue that research on the placebo effect has the potential to revitalize the art of medicine.

End-of-life care education for psychiatric residents: attitudes, preparedness, and conceptualizations of dignity.

OBJECTIVE: The authors examined psychiatric residents' attitudes, perceived preparedness, experiences, and needs in end-of-life care education. They also examined how residents conceptualized good end-of-life care and dignity. METHODS: The authors conducted an electronic survey of 116 psychiatric residents at the University of Toronto. The survey had a mix of qualitative and quantitative questions. RESULTS: Eighty-two of 116 invited psychiatric residents participated for a response rate of 71%. With favorable attitudes, residents felt least prepared in existential, spiritual, cultural, and some psychological aspects of caring for dying patients. Trainees conceptualized dignity at the end of life in a way very similar to that of patients, including concerns of the mind, body, soul, relationships, and autonomy. Residents desired more longitudinal, contextualized training, particularly in the psychosocial, existential, and spiritual aspects of care. CONCLUSION: This is the first study to examine the end-of-life educational experience of psychiatric residents. Despite conceptualizing quality care and the construct of dignity similarly to dying patients, psychiatric residents feel poorly prepared to deliver such care, particularly the nonphysical aspects of caring for the dying. These results will inform curriculum development in end-of-life care for psychiatric residents, a complex area now considered a core competency.

Restoring the spiritual: reflections on arrogance and myopia-allopathic and holistic.

Over the past two decades, researchers have successfully accumulated lots of data pointing to a salutary impact of religious involvement. But progress in the religion and health field has been inhibited by the relative lack of attention to important conceptual and theoretical issues. This paper asserts that until we focus as much on the latter as on the former, this field will remain marginalized and thus ineffective in contributing to understandings of the determinants of health and healing. Careful attention to the how and why of a religion-health connection is imperative for bringing this research into the mainstream of biomedicine.

Teaching the art of healing.

The Healer's Art is a course based on the work of Rachel Naomi Remen, M.D., that is designed to explore the art of medicine with medical students. It has been offered as an elective to second-year medical students at the University of Minnesota Medical School's Duluth campus since 2003. The course leads students into dialogue about what, beyond science and technology, they as physicians will be able to offer patients. It also encourages participating faculty members to rediscover their passion for medicine. This article describes the course, the reasons for its creation, and the lessons students and faculty take away from it.

Having pity on our victims to save ourselves: Compassion reduces self-critical emotions and self-blame about past harmful behavior among those who highly identify with their past self.

Previous research has shown that people often separate the present self from past selves. Applying knowledge gained from intergroup research to the interpersonal domain, we argue that the degree to which people identify with their past self (self-identification) influences their reaction when recalling a past event during which they harmed another person. Because they feel close to their past self, we expected this to be threatening for high self-identifiers, and expected them to be motivated to avoid self-critical emotions and blame. Using four meta-analyses, conducted on a set of seven experimental studies, we investigated four ways in which high self-identifiers can distance themselves from the event: by feeling compassion, by taking a third-person rather than first-person perspective, by emphasizing ways in which their present self is different to their past self, and by disidentifying with the past self altogether. We found the strongest interaction effects for compassion: whereas a compassion manipulation increased self-critical emotions and self-blame about the past event for low self-identifiers, it decreased them for high self-identifiers. We argue that this occurs because the other-focused nature of compassion allows high self-identifiers subtly to shift the focus away from their harmful behavior. Our concept of past self-identification had stronger effects than a measure of self-continuity beliefs. It also correlated only moderately with the latter, suggesting they are distinct concepts. Our findings suggest that, ironically, the most effective way to protect the self against reminders of an undesirable past, may be to have compassion for our victims.